Welcome to European Tribune. It's gone a bit quiet around here these days, but it's still going.

Poor Britons healthier than rich Americans

by Jerome a Paris Thu May 4th, 2006 at 07:15:34 AM EST

Some good news to contrast with Agnes a Paris's relative pessimism on the NHS:

Study Shows Americans Sicker Than English

White, middle-aged Americans even those who are rich are far less healthy than their peers in England, according to stunning new research that erases misconceptions and has experts scratching their heads.

Americans had higher rates of diabetes, heart disease, strokes, lung disease and cancer findings that held true no matter what income or education level.

Those dismal results are despite the fact that U.S. health care spending is double what England spends on each of its citizens.

The upper crust in both countries was healthier than middle-class and low-income people in the same country. But richer Americans' health status resembled the health of the low-income English.


Display:
I wonder how much of that is down to different cultural attitudes to health?

Incidentially:

Robert Blendon, a professor of health policy at the Harvard School of Public Health who was not involved in the study, said the stress of striving for the American dream may account for Americans' lousy health.

"The opportunity to go both up and down the socioeconomic scale in America may create stress," Blendon said. Americans don't have a reliable government safety net like the English enjoy, Blendon said.

I guess he doesn't read Eurotrib.

by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 07:33:41 AM EST
They feel they've corrected for culture:
These surveys contain extensive and comparable biological disease markers on respondents, which are used to determine whether differential propensities to report illness can explain these health differences.

Conclusion  Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution.
by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 07:36:43 AM EST
[ Parent ]
Their methodology is highly dubious.

Most of the differences are probably related with cultural differences. Mostly what they eat how you eat, work, sleep, stress, little walks, constant laughs, sex...well all those stuff that the scientific community knows so well but somehow nobody cares about...

These are really dificult to pinpoint to markers and are only uncovered doing high number of statistics and tracking the biochemistry...

In any case..only a fool will pick up the american system.

A pleasure

I therefore claim to show, not how men think in myths, but how myths operate in men's minds without their being aware of the fact. Levi-Strauss, Claude

by kcurie on Thu May 4th, 2006 at 09:57:41 AM EST
[ Parent ]
I meant the cultural attitude to reporting and investigating illness: I'd expect Brits to be more likely not to self-report as having illnesses than USians.
by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 10:01:06 AM EST
[ Parent ]
I should have included this in my list, for sure...

But do not forget the rest....I know my view of health and medicine is not very standard (I think science fails miserably on it) but I would say that the above list and hygiene are considered the perfect indicators of the average health of a society...

Other than that particualr food or customs can make some illness disappear completely...and I think it is very difficult to account for it.

But NHS in fornt of US always.

A pleasure

I therefore claim to show, not how men think in myths, but how myths operate in men's minds without their being aware of the fact. Levi-Strauss, Claude

by kcurie on Thu May 4th, 2006 at 10:08:32 AM EST
[ Parent ]
Agnes is correct to be pessimistic about trends in the NHS. My understanding is that nobody denies that something like these reforms are needed, but that their implementation is being pushed too quickly on the cheap for them to produce anything other than chaos in their wake.

Nevertheless, the US system is notoriously bad at delivering reasonable care to anybody who isn't in the multi-millionaire category, insured or not. That, coupled with a cultural tendency towards celebrating conspicuous consumption, has left the middle aged american prey to many health issues that, according to this survey, appear mostly lifestyle related.

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Thu May 4th, 2006 at 07:34:38 AM EST
Strangely enough, from the same edition of the JAMA:
Conclusions  Even among higher-income adults, lack of health care insurance was associated with significantly decreased use of recommended health care services; increased income did not attenuate the difference in use between uninsured and insured adults. Efforts to improve the use of recommended health care services among the uninsured should focus on patient education and expanding insurance eligibility for both lower-income and higher-income adults.
by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 07:40:42 AM EST
[ Parent ]
Worthy ambitions, but the legislative tendency under the US administration is going in the other direction.

I had my ear bent by an American couple for an hour last saturday on the train on the inadequacies of US healthcare (and other issues ;-)))

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Thu May 4th, 2006 at 07:56:20 AM EST
[ Parent ]
You don't have to be a multi-millionaire to get good health care in the U.S. What you need is to be employed at a job that has health benefits and that pays enough so that you can cover the deductable. Most insurance plans have an annual maximum of a couple of thousand dollars, so if you have a "reasonable" job, you have access to the best health care anywhere.

The problem with American health coverage is that below a certain point you fall out of the insurance system, and into the state supported system which is not nearly as good and which varies widely from state to state. Some states have excellent coverage for everybody, while others offer essentially nothing.

Note also that one of the ways the debate is distorted in the American political debate is by saying "X million people don't have health insurance," which is misleading because the numbers typically don't account for the people covered by the state plans. For example, hardly anybody has health insurance in Europe--because the state covers them.

Please be careful about filtering the distortions that come in partisan political debate from the real issue, which is that poor people have inadequate coverage.

And I think the whole point of this Britain versus American health article is that after they account for all of the factors they can think of, Americans still have worse health. It's not a matter of health coverage differences, it's a question of "what is going on here in our model?"

by asdf on Thu May 4th, 2006 at 08:42:15 AM EST
[ Parent ]
Efforts to improve the use of recommended health care services among the uninsured should focus on patient education and expanding insurance eligibility for both lower-income and higher-income adults.
by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 09:20:26 AM EST
[ Parent ]
Of course, if you are actually ill, you might find that the vaunted "best care anywhere" is ringed with protections to keep various treatments from being used.

(This does of course happen in a lot of systems, but US system boosters are the most egregious in attempting to pretend it doesn't happen.)

by Metatone (metatone [a|t] gmail (dot) com) on Thu May 4th, 2006 at 12:32:06 PM EST
[ Parent ]
The U.S. bashing here today is unbelievable. The places that have trouble with denying people promised care are the ones like Canada and Britain and France that can't keep up with the demand. This simply isn't the problem with the U.S. system.
by asdf on Thu May 4th, 2006 at 10:51:55 PM EST
[ Parent ]
This is not bashing, it's criticising a system that is broken.  I'm in the US and I have a lot of family here and in Britain.  As far as medical care I'd much rather be in Britain.  Forget the propaganda, asdf, and look at the studies and reports of Americans who have no insurance or cannot get medical care, yet we spend more than the other nations.

We don't have a problem "keeping up with demand" because we simply refuse to treat a lot of people.  I know this not only because I've read it, but because I've had painful experience in this area.  Right now, this very moment as I type, I am in need of some fairly routine medical treatment.  

I've needed this treatment since 1999.  I have pretty good insurance, yet I am not allowed the treatment.  It's medically necessary, but not covered.  I won't die from not having it, but my quality of life is quite severely affected.  I know other people in the same boat.  I know people who can't have the medications they need, or who can't afford their co-pays.  

What do you call that, asdf?  It's not "rationing" and it's not even having to be on a waiting list.  I don't know what it's called, but when you have no options it feels like "fuck you healthcare."  Maybe there's a nicer name.  

The reason I talk about this isn't to bash America, it's to identify a problem which, last I checked, is the first step in solving it.  And I want to solve this problem, I really do.  When you deny the problem, what are you hoping to accomplish?

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Thu May 4th, 2006 at 11:38:20 PM EST
[ Parent ]
I agree that the American system is broken. I too have friends and family members for whom the system is not working.

And there are striking differences in attitudes towards medicine. Here, people pop pills like crazy, which skews the spending towards useless pharmaceutical research. In Britain, as I'm sure you know, you don't just take a cold pill or four, you tough it out.

The American system is the most expensive system, and it doesn't allocate services fairly, and it doesn't give good results. I agree with you. Personally I support single payer, unlike either of our political parties. I'm not expressing myself clearly, there's no question about that.

My reading of Metatone's comment was that in America you have insurance but don't get coverage. That is not the case, generally. (I don't know what your specific situation is.) On the other hand it is absolutely the case in countries with socialized medicine when they can't keep up with demand. Canadian surgery waiting lists. British dentist waiting lists. As you know.

Again, the problem with the American system is that it allocates health coverage unfairly.

by asdf on Thu May 4th, 2006 at 11:51:26 PM EST
[ Parent ]
Well, it seems to me all the hand-wringing about waiting lists, etc., is overblown right-wing propaganda -- not that the systems don't have problems or that this doesn't happen, but I don't think it's as bad as all that.  I've never known of one of my relatives who didn't get the medical care they needed in Britain.  

My nephew once had to wait two weeks for allergy testing, but otoh, I recently had to wait three weeks to get an appointment with a GI doc.  I don't see a lot of difference between those waits, except one was called a "waiting list" and the other was called "all booked up."

My reading of Metatone's comment was that coverage doesn't always mean coverage for everything.  There's no denying that this is indeed the case with many insurance plans here in the U.S.  Of course, there are hundreds of plans, so I'm sure there are many examples of the system working really well, but especially with HMOs, there are countless hurdles and exclusions and ways to disqualify a person from getting needed treatment.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Fri May 5th, 2006 at 12:09:45 AM EST
[ Parent ]
Note also that one of the ways the debate is distorted in the American political debate is by saying "X million people don't have health insurance," which is misleading because the numbers typically don't account for the people covered by the state plans

Government plans including federal and state both count as insurance.  The number of uninsured is indeed the number of people without coverage.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Thu May 4th, 2006 at 02:41:53 PM EST
[ Parent ]
All of this is based on the belief (from the Anglo-Saxon root meaning "to wish") that technological health care is the best route available for disease prevention and disease treatment. Just as our survival depends on a broader perspective of energy sources as we pass peak oil, our health care systems require a broader, more inclusive perspective to offer people a healthy life.

IMHO. :-)

by US Blues on Thu May 4th, 2006 at 10:02:20 AM EST
Now crossposted on dKos (with added graphs): http://www.dailykos.com/story/2006/5/4/11451/82627

In the long run, we're all dead. John Maynard Keynes
by Jerome a Paris (etg@eurotrib.com) on Thu May 4th, 2006 at 11:19:40 AM EST
This is all the more striking as:

The USA actually spend more public money on healthcare than the UK does, in addition to tons more of private money ( (Source - click on pic for bigger version):

The UK actually has the highest obesity rates in Europe, with numbers not that different from the USA (Source (pdf)):



As the Yahoo article points out, there is no obvious explanation for that difference. Maybe all the private money being spent is the explanation - people are just sick of it...

In the long run, we're all dead. John Maynard Keynes

by Jerome a Paris (etg@eurotrib.com) on Thu May 4th, 2006 at 11:20:43 AM EST
[ Parent ]
Wow, the US has the third highest public per-capita PP expenditure!

Then again, a lot of that may be because health care workers (and doctors) have higher salaries in the US than in most other countries. I think expenditur as a fraction of GDP are a good way to correct for that effect.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman

by Migeru (migeru at eurotrib dot com) on Thu May 4th, 2006 at 11:28:55 AM EST
[ Parent ]
It's corrected to some extent by the use of PPP numbers.

They are spending incredible amounts on healthcare, yes.

In the long run, we're all dead. John Maynard Keynes

by Jerome a Paris (etg@eurotrib.com) on Thu May 4th, 2006 at 11:36:21 AM EST
[ Parent ]
I noticed the PPP. But the labour costs in the US health sector may be higher than in other countries, even measured by PPP. Definitely higher than average for the OECD.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman
by Migeru (migeru at eurotrib dot com) on Thu May 4th, 2006 at 11:37:54 AM EST
[ Parent ]
So 4 out of the 6 fattest rich nations on that chart (I removed Mexico for not being 'rich') are "anglo-saxon", while 2 of the 4 least fat ones have French as a national language?

// alex throws this heaping steam of manipulative nonsense into the room and then runs out through a backdoor

by Alex in Toulouse on Thu May 4th, 2006 at 04:45:31 PM EST
[ Parent ]
If sicker people go into system A than system B, System B's outcomes will be better.  Scientific clinical trials all over the world are carefully designed to screen out this bias.  From Mind the gap: England found to be healthier than America
However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed.

Both said it might explain better health for low-income citizens, but it can't account for better health of Britain's more affluent residents.

"It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said.

I agree with asdf's comments above.

Personally, if I come down with an illness, I wanted to be treated in the US.

by wchurchill on Thu May 4th, 2006 at 03:53:58 PM EST
I meant to say, our lifestyles have a lot to be desired.  We inflict a lot upon ourselves in America, on our health.  But in most cases, that is a personal decision.  You don't have to be overweight, or be stressed.
by wchurchill on Thu May 4th, 2006 at 03:56:03 PM EST
[ Parent ]
You don't have to ... be stressed.

Unless you're poor of course.

by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 04:06:17 PM EST
[ Parent ]
I meant that spiritually.  There are many examples throughout history of people having literally nothing, but being at peace.  we both, likely, know some people like that--I do.  we define ourselves, and our level of peace.  the west has become so materialistic that we tend to deny this today.  IMHO, that is.
by wchurchill on Thu May 4th, 2006 at 04:20:27 PM EST
[ Parent ]
Being unable to live a "decent" lifestyle is intrinsically stressful: the definition of decent is of course an issue. There's a diary I have to write about that.

And please tell me you didn't mean that poor people would be healthier if only they accepted their lot!

by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 04:38:31 PM EST
[ Parent ]
didn't say that.
by wchurchill on Thu May 4th, 2006 at 04:39:40 PM EST
[ Parent ]
Good!

It just sort of could sound that way if you were in both cranky at other people and spending half your attention on category diagrams (don't ask!)

by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 04:41:18 PM EST
[ Parent ]
Unhappines comes from misplaced desires. Accept your station in life and live in bliss. Hare Krishna Hare Rama...

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman
by Migeru (migeru at eurotrib dot com) on Thu May 4th, 2006 at 04:40:39 PM EST
[ Parent ]
Why did you skip "overweight"? Poor people have fewer choices in what they eat. Fast food is dead cheap (99 cent tacos, and 99 cent big macs). At supermarkets in poorer areas the produce is less fresh, there are less pressed juices and more juices from concentrate, or "juice drinks", with higher sugar content, the milk is of poorer quality... The "processed cheese food" and "processed meats" have higher fat content, the baked goods are made with hydrogenated oil... After I found out that Ralphs (an upmarket supermarket chain) owned Food4Less (a low-end chain), the few times I happened to find myself at a Food4Less I took it as an exercise in class awareness.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman
by Migeru (migeru at eurotrib dot com) on Thu May 4th, 2006 at 04:29:37 PM EST
[ Parent ]
I know, but it's easier to argue that a bit of thought and self-control would offset that. Not that one has time with two jobs and kids.
by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 04:40:00 PM EST
[ Parent ]
If you have the income, you can substitute healthier, more expensive foods. But if you don't have the income you still have to get your 1500 - 2000 calories by eating  crap, or eat better food but be hungry.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman
by Migeru (migeru at eurotrib dot com) on Thu May 4th, 2006 at 04:41:47 PM EST
[ Parent ]
I know that - and if you're working in a physically demanding job you need a lot more that 1500 calories.
by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 04:43:12 PM EST
[ Parent ]
But that's the thing, you don't have to be poor.
by Alex in Toulouse on Thu May 4th, 2006 at 04:47:50 PM EST
[ Parent ]
Did you see my graph above that shows that Britons pretty much have the same obesity problems as the USA? So it's not just the health, it IS the healthcare as well.

That really seems something that you cannot admit to. Why?

In the long run, we're all dead. John Maynard Keynes

by Jerome a Paris (etg@eurotrib.com) on Thu May 4th, 2006 at 04:39:08 PM EST
[ Parent ]
yes, I saw that a read it in one of the articles.  but obeisity is not the only life style factor that influences health.
by wchurchill on Thu May 4th, 2006 at 04:42:54 PM EST
[ Parent ]
Driving everywhere and not walking enough also playes a role.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman
by Migeru (migeru at eurotrib dot com) on Thu May 4th, 2006 at 04:44:07 PM EST
[ Parent ]
Possibly more than obesity. It's possible to be fit and obese as well as unfit and obese. Obesity by itself may or may not be a massive risk factor.

There's a pretty strong correlation between obesity and unfitness of course.

by Colman (colman at eurotrib.com) on Thu May 4th, 2006 at 04:45:39 PM EST
[ Parent ]
I knew of two main types of obesity, one which is risky, the other one not particularly (android vs genoid), but there are certainly many more.
by Alex in Toulouse on Thu May 4th, 2006 at 04:53:39 PM EST
[ Parent ]
I may have commented before that my baseline weight while I was in the US was 10 pounds higher than in Europe... and I didn't drive. I took about 2 weeks two gain or lose the 10lb.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman
by Migeru (migeru at eurotrib dot com) on Fri May 5th, 2006 at 01:54:58 AM EST
[ Parent ]
Alex touched on the different sorts of obesity, but your note is also a good one.  Compare (say) the obese truck driver with the obese NFL lineman.  The truck driver would have difficulty running 40 yards.  The NFL lineman can do it in four and a half seconds.  (I'm about ten pounds underweight, and on my best day I can't run it in that time.)  That connects with Migeru's point, as well.

Be nice to America. Or we'll bring democracy to your country.
by Drew J Jones (pedobear@pennstatefootball.com) on Sun May 7th, 2006 at 12:49:40 PM EST
[ Parent ]
That is because obesity is usually defined by Body Mass Index only, which assumes that everyone has the same body type.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman
by Migeru (migeru at eurotrib dot com) on Sun May 7th, 2006 at 12:52:43 PM EST
[ Parent ]
I agree with asdf's comments above.

Yet asdf's comment is wrong.  The 46 million number are indeed people without any insurance.  Not only that, it not a measurement of "at that moment in time."  It's uninsured for a whole year.  The moment in time snapshot brings the number of uninsured over 60 million.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Thu May 4th, 2006 at 04:59:04 PM EST
[ Parent ]
To clarify, the 46 million people without health insurance number is the self-reported Census number, with various caveats and skewing factors. But that doesn't matter, because it's clearly too many people, and many of them are the least privileged in the country--although that is changing as the cost of individual insurance rises. It's a horrible system.

However, that is not what the article is about...

by asdf on Thu May 4th, 2006 at 11:38:46 PM EST
[ Parent ]
I'm not speaking to the article, but to the comments.  It's funny to hear you say ours is a horrible system -- I didn't get that you held that view by your prior comments.  Perhaps, in this new light, my comment above was worded too harshly.  This being the case, however, what is it you object to in critiques of this system?

Maybe we can eventually make language a complete impediment to understanding. -Hobbes
by Izzy (izzy at eurotrib dot com) on Thu May 4th, 2006 at 11:44:06 PM EST
[ Parent ]
What I'm having trouble with is the America bashing tone that sometimes creeps into the ET discussions has crept in today.

The American health care system is stupid. Everybody in America knows that, and we're struggling to figure out what to do. Fine. So where's the discussion, for example, (on a European blog) about the mile long queue to sign up for a new dental practice in England? How are you going to convince Americans that this is better?
http://news.bbc.co.uk/1/hi/england/lincolnshire/4367717.stm

Or, off this topic, when Britain and France introduce an Iran-sanctioning proposal at the U.N. there is this mad scramble to explain how it's actually an unbelievably convoluted scheme to undercut the aggressive American Empire. The possibility that the European governments are also worried about Iran is taboo.

It's like "everything about America is bad and everything about Europe is terrific." I prefer to see a discussion about the positive and negative on both sides of the pond, which on most days is how it goes. But not today.

by asdf on Fri May 5th, 2006 at 12:00:02 AM EST
[ Parent ]
You know, I live in a relatively poor (thoght there is worse) borough of London and I had no trouble whatsoeaver registering with a doctor (GP). I even had a choice of several different practices within walking distance of my home.

I'm behind on my dental and eye check-ups so I'll try to register with an eye doctor and a dentist shortly. I'll let you know how not-horrible it is.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman

by Migeru (migeru at eurotrib dot com) on Fri May 5th, 2006 at 01:58:14 AM EST
[ Parent ]
Dentist is likely to be a problem if you try to register as an NHS patient - there is a general shortage exacerbated by recent changes to their contracts, one very bad aspect of the NHS.

Any major high street will have probably three or four opticians, any of who will offer NHS sight tests for the £15 fee, You do not have to buy any glasses or contact lenses from them, just ask them to give you the prescription which you can use at any shop. As well as the reading tests, they will also examine your eyes and do other tests as appropriate. They will take a family history to look out for some problems (if you are over a certain age - 50 I think - and your parents had glaucoma you get the test free). You also get the test free if you are over 65 or in one of other exempt groups and some get vouchers to help pay for them. Cost will depend on the frames and type of lens and coatings you chose. Obviously if you need bifocals or varifocals the cost will be higher. There are several major chains and they frequently do special offers - one chain does a "two for one" offer, handy if you need reading and distance glasses (though you have to pay for coating the second pair) or at this time of year they do free light-sensitive lenses instead. Shop around for the best deal for you.

If they detect any problems they will either give you a letter for your GP or refer you to a hospital opthalmology department.  

by Londonbear on Fri May 5th, 2006 at 03:25:27 AM EST
[ Parent ]
Sorry to contradict Jerome but if you look at the data sets used you will find they are for England only (See my diary of yesterday on Booman). The four countries in the UK have separate health services, administerd by the local assemblies/parliament while England is controlled by Westminster.

Scotland in particular has much higher rates of coronary heart disease and alcoholism than England. There seems to be a genetic link to Celts having a predispostion to alcohol dependance.

The BBC item on this interviews a couple of the researchers of the report and it looks like there are societal factors in play. I surmise it might be that there are different work patterns. Certainly the English have far more holiday time than Americans. While the data would not have been affected by the working time directive, it is not untypical for there to be both shorter time at work and shorter commuting times in England. Certainly for middle class professionals or central/local government office staff, there are possibilities of taking retirement at a much earlier age than in the USA. This cohort benefits from index-linked rises in pensions resulting in much less stress than Americans retiring on either fixed pensions or having to rely on annuities purchased from lump sum savings.

One other factor also strikes me. The age group examined were either born just before or just after WWII. The data is for 54-65 year old in 2002/3, making their birth dates between 1938 and 1948. Even the youngest would have started school before rationing of sweets ended. The older group would have been children under full rationing where meat and fats in particular were restricted. I am a few years younger than the group. My family was still getting a lot of fresh vegetables from my grandfather's allotment, a small area of land in a local park for locals to have to grow vegetables. A great treat was picking blackberries from their house's garden. Now studies of the heath of the nation showed that rationing produced a radical improvement in the health of all socio-economic groups.  I wonder whether the early eating experience of the English cohort had an effect on these results in later life.

by Londonbear on Thu May 4th, 2006 at 07:08:49 PM EST
Now studies of the heath of the nation showed that rationing produced a radical improvement in the health of all socio-economic groups.

wow!  can you provide urls?

this raises all kinds of questions and implications, especially for the generation which experienced rationing as kids and teens, and swore to themselves "Never again, dammit."

The difference between theory and practise in practise ...

by DeAnander (de_at_daclarke_dot_org) on Thu May 4th, 2006 at 07:14:23 PM EST
[ Parent ]
Frustratingly I cannot immediately find references to the primary sources but this from a .pdf British Butrion Association booklet gives the process:


During the Second World War (1939-1945) the British
government introduced food rationing to make sure that
everyone received their fair share of the limited food which was
available. Food rationing started in 1940 and finally ended in
1954. To start with only a few foods were rationed, but more
foods were included as the years passed. The rations of food
varied throughout the war and additional allowances were given
to certain groups. Each person was given a ration book. A
'points' scheme was introduced for unrationed foods. Each
person was allocated a number of points and a selected range of
foods was given a point value. The consumer could choose how
to spend these points. Many people were better fed during
wartime food rationing than before the war years. Infant mortality rates declined, and the average age
at which people died from natural causes increased.
The wartime food shortages forced people to adopt new eating patterns. Most people ate less meat,
fat, eggs and sugar than they had eaten before. But people who had a poor diet before, were able to
increase their intake of protein and vitamins because they received the same
ration as everybody else.
The `National Loaf' was introduced. It was made with more
grain then was used in white bread, resulting in a brown loaf.
White bread was no longer available and brown bread
became the norm.
Part of the work of the Ministry of food was to give advice to
the British public about how to make the best of the food that was available. This
included radio broadcasts, cookery demonstrations and recipe leaflets.
'Dr Carrot' and 'Potato Pete' were characters introduced to
encourage people to eat home grown vegetables which were plentiful.
Many people grew their own vegetables, and kept hens to
supplement their rations.
Special arrangements were young
children, expectant and nursing mothers
to receive cod-liver oil, orange juice and
milk from welfare clinics. When the
oranges were available children under six
years of age were entitled to receive 1lb
each week. The general health of children
improved and on average they were taller and heavier than children born
before the war.

A newsletter of the American Academy of Anti-Aging Medicine  had this in the precis of an article on rationing.


Many people were better fed during wartime food rationing than before the war years. Infant mortality rates declined, and the average age at which people died from natural causes increased

The effects are further detailed here


Towards the end of World War II it was noted that overall the health of the British nation improved quite dramatically, despite rationing. On the whole national statistics reflected that individuals were healthier and notably more slender in their physique. Due to the fact that poorer members of society were able to eat better-balanced and nutritionally superior diets, as everyone was given equal entitlement to foods. Food and drink supplements were provided for pregnant mothers, children and the elderly ensuring everyone was catered for.

Even more interesting is this from a personal web site of a member of this cohort.


With hindsight the denial of sweets, confectionery, cakes, chocolate and sugary drinks in my younger years was a blessing as it means I have never craved for these items, apart from 5 February 1953 when sweet rationing ceased and my brother and I were given an extra week's pocket money 6d [2 ½ pence] to get a quarter of a pound, [4 ounces or 115 g approx.] of whatever sweets we wanted
by Londonbear on Thu May 4th, 2006 at 08:39:36 PM EST
[ Parent ]
thank you londonbear!

illustrates several (somewhat disturbing) points.

  1. what we want is not necessarily good for us

  2. "high status" foods like refined sugar and refined flour are pathogenic enough that vulgarising their availability may have profound public health implications

and I'm sure a lot more as well.  add to the mix Monbiot's latest interesting suggestion that junk food consumption may be related to crime rates.

Does television cause crime? The idea that people copy the violence they watch is debated endlessly by criminologists. But this column concerns an odder and perhaps more interesting notion: if crime leaps out of the box, it is not the programmes that are responsible as much as the material in between. It proposes that violence emerges from those blissful images of family life, purged of all darkness, that we see in the advertisements.

Let me begin, in constructing this strange argument, with a paper published in the latest edition of Archives of Pediatrics and Adolescent Medicine. It provides empirical support for the contention that children who watch more television eat more of the foods it advertises. "Each hour increase in television viewing", it found, "was associated with an additional 167 kilocalories per day"(1). Most of these extra calories were contained in junk foods: fizzy drinks, crisps, biscuits, sweets, burgers and chicken nuggets. Watching television, the paper reported, "is also inversely associated with intake of fruit and vegetables".

There is no longer any serious debate about what a TV diet does to your body [...]
But the more interesting question is what this diet might do to your mind. There are now scores of studies suggesting that it hurts the brain as much as it hurts the heart and the pancreas. Among the many proposed associations is a link between bad food and violent or anti-social behaviour.

The most spectacular results were those reported in the Journal of Nutritional and Environmental Medicine in 1997(3). The researchers had conducted a double-blind, controlled experiment in a jail for chronic offenders aged between 13 and 17. Many of the boys there were deficient in certain nutrients. They consumed, on average, only 63% of the iron, 42% of the magnesium, 39% of the zinc, 39% of the vitamin B12 and 34% of the folate in the US government's recommended daily allowance. The researchers treated half the inmates with capsules containing the missing nutrients, and half with placebos. They also counselled all the prisoners in the trial about improving their diets. The number of violent incidents caused by inmates in the control group (those taking the placebos) fell by 56%, and in the experimental group by 80%. But among the inmates in the placebo group who refused to improve their diets, there was no reduction. The researchers also wired their subjects up to an electroencephalogram (which records brainwave patterns), and found a major decrease in abnormalities after 13 weeks on supplements(4).

A similar paper, published in 2002 in the British Journal of Psychiatry, found that among young adult prisoners given supplements of the vitamins, minerals and fatty acids in which they were deficient, disciplinary offences fell by 26% in the experimental group, and not at all in the control group(5). Researchers in Finland found that all 68 of the violent offenders they tested during another study suffered from reactive hypoglycaemia: an abnormal tolerance of glucose caused by an excessive consumption of sugar, carbohydrates and stimulants such as caffeine(6). In March this year the lead author of the 2002 report, Bernard Gesch, told the Ecologist magazine that "having a bad diet is now a better predictor of future violence than past violent behaviour. ... Likewise, a diagnosis of psychopathy, generally perceived as being a better predictor than a criminal past, is still miles behind what you can predict just from looking at what a person eats."(7)

Why should a link between diet and behaviour be surprising? Quite aside from the physiological effects of eating too much sugar (apparent to anyone who has attended a children's party), the brain, whose function depends on precise biochemical processes, can't work properly with insufficient raw materials. [... more ...]

I have references somewhere to a high school which switched its cafeteria over to strictly healthy/organic cooking and banned soft drink and candy machines from the campus.  behavioural problems among the children diminished dramatically.  I'll try to find it in the chaos of my filing [hah!] system.

The difference between theory and practise in practise ...

by DeAnander (de_at_daclarke_dot_org) on Thu May 4th, 2006 at 08:57:24 PM EST
[ Parent ]
The English chef and TV cook did a whole series "Jamie's School Dinners" where he went into a school and changed the food from what was essentially fast food take away to  freshly prepared healthy food.  There was an improvement in concentration, a dramatic fall-off in children needing to take asthma inhalers during the day and an improvement in results and behaviour. The experiment was so successful it was rolled out to all the London Borough's schools (Greenwich) This was part of a campaign he has to improve school meals which has its own web site  In the occasional diary he writes he mentions visiting the USA.
by Londonbear on Thu May 4th, 2006 at 10:07:00 PM EST
[ Parent ]
forgive my vulgar curiosity... but why are you awake?

The difference between theory and practise in practise ...
by DeAnander (de_at_daclarke_dot_org) on Thu May 4th, 2006 at 10:11:01 PM EST
[ Parent ]
Local election results in short. My local party (Lib Dems) have gained 10 council seats from Labour to move the council to no overall control, the first time since 1971 that they have lost control. I am waiting on the results for Tower Hamlets where there are strange things going on as seats are "churning" with Labour gaining 3 from Lib Dems and Conservatives gaining 6 from Labour. Last time there were reports the areas where George Galloway's Respect party are considered strongest are still to come in.

As I am on "second wind" I'll just post a couple of comments about what you can actually expect if you are acutely ill here. If I need to see a general practioner I can get an appointment in 48 hours, if urgent I can go to the surgery and wait a couple of hours max to get an emergency slot. Out of surgery hours I can either go to a local centre or call out a doctor for a home visit  from the locum service (how many American doctors do that?) I live a half hour bus ride from two hospital minor injuries units run by GPs and nurse-practioners. On each of the two times I have had to use them I was seen within about 10 minutes of booking in at recption. Ambulance service is free and most crews now are fully trained paramedics who can stabilise patients instead of doing a "scoop and run". You can also get free advice from trained nurses on a local rate telephone call system. They either give self-help advice or refer you to a doctor or call an ambulace for you. Called "NHS Direct", they also have a web site that duplicates much of the "decision tree" expert systems that they use for the advice.

My local doctors' surgery has clinic sessions for dieticians, psychogical counselling, osteopathy, baby checkups and innoculation. It also does minor surgery (like removing a skin tag that my shirt collar kept knocking and a couple that were just annoying). I get annual flu injections as I am considered "high risk" because alergies can very infrequently give me a mild asthma. One of the doctors does acupuncture treatments and they can refer you to subsidised exercise sessions in the local swimming pool/gym. Non-urgent hospital treatment can mean waiting but the times are coming down. The main difference in quality is the "hotel accommodation" as there are still multi-bed wards - though these are now often arranged as 6-8 bed "bays" in the newer hospitals. Some operations are being carried out in private hospitals to reduce waiting times. These are fairly widely available as the better off take out private insurance to get better "hotel facilities" like  individual rooms or to be able to specify the date for a treatment. If you have an acute illness like cancer, a hospital will admit you for treatment virtually immediately.

All is certainly not roses. There are ridiculous financial problems resulting hospitals having to make staff redundant because of changes to their funding. Bed occupancy is so high that the risk of catching infections like MRSA are increased. Many have had to "contract out" services like cleaning and laundry to private companies who can provide inferior servies to the old in-house systems. At the moment there are some areas where quick access to sexually transmitted disease clinics can be difficult - meaningeitherr ou have to shop around to find one that has a limited "walk in" system or making an appointment. This particular problem seems to result from a combination of the underfunding of a "cinderella" service and an increase in demand from patients wanting a sexual health check-up as a result of publicity.

You should also realise that the service is organised semi-locally into "health care trusts" covering say a county or couple of London Boroughs. Drugs are both licensed for use (ie declared safe like FDA approval) and new ones are approved for use as cost-effective by a central body called N.I.H.C.E. (pronouced nice as the H was added later) Their decisions can cause problems - an example being their refusal to approve inhaled insulin for general use. The local Trusts can refuse to pay for treatments not passed by NIHCE - a current one is a treatment for early breast cancer which is only effective in certain cases and is marginally more effective than existing therapies.

A large part of the financial overspend (actually a measly 1% of the whole budget if you take the country as a whole) is down to the effect of considerable improvements in nurses' pay and the pay and conditions of doctors. These are now about the highest in Europe and a lot of doctors have come from other EU countries to work here. This has recently caused a scandal as trainee doctors from non-EU countries who qualify are having to apply for work visas that they might not automatically get.

If there are problems, a lot  can be traced back to the government's constant re-organisation of the structures and slavish aherence to targets like reducing waiting times without reference to clinical urgency.

If you look at the cost to the individual, it works out at about 16% of pay, split between employer and employee but that also includes payments for a basic retirement pension. Obviously the young, unemployed and those retired over 60/65 (the retirement age for women and men) do not make these payments. (The difference between these contributions and the actual costs are made up from general taxation) Drug costs are a flat £6.75 (around $12) per drug on a NHS prescription, free for the young, elderly and those on very low incomes. Pharmacies can also sell a number of drugs over the counter and dispense some items like the "morning after pill" without having to get a doctor's prescription.

While the system may not be perfect, it certainly offers a far higher proportion of the population virtual immediate access to advice and urgent treatment than in the USA. Of course there are differences. You might not get an MRI or CAT scan if a standard x-ray will provide an equally good diagnosis. On the other hand the Accident and Emergency Departments (Emergency rooms) are not clogged with the poor getting treatment for chronic illnesses. Apart from those in high risk groups, women do not get breast x-rays every year. (Rather more scandalously men do not get regular testing for prostate cancer. They are also far less likely to have very early operations for it, which may not be so bad if you consider most are very slow growing and quite frankly a  70 year old will die of other things before a newly diagnosed prostate cancer will kill them, plus they do not have to live with the common side-effects. The recommended practice now is not to give drugs for mild to moderate depression in the first instance. Self-help like exercise is likely to be suggested, then talking therapies offered and only if these do not work are drugs recommended. This NIHCE recommendation is fairly recent so the effects have not fully worked through the system yet. One important difference in the approach is that young people should not be given drugs except in very severe cases and then only certain very safe ones should be given. You may know that some of the anti-depressants have potentially fatal side-effects as they can produce inappropriate violent behaviour to either self harm or attack others.

by Londonbear on Fri May 5th, 2006 at 02:52:00 AM EST
[ Parent ]
Regarding avoiding drugs if possible, our child has had mild cases of conjunctivitis twice in 18 months. The first time they gave him antibiotic eye drops, but the second time I was told 1) we should just throughly wash his eyes with water; 2) if after a couple of days it didn't get better we could go to the pharmacy (we have one right across the street, and several others within 15min walking or bussing distance) and get the antibiotic eye drop without a prescription. As we had reacted early, just washing his eyes with water worked.

I personally have an aversion to self-medication and like a doctor whose first reaction is not to prescribe antibiotics.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman

by Migeru (migeru at eurotrib dot com) on Fri May 5th, 2006 at 04:26:17 AM EST
[ Parent ]
Your arguments about diet and rationing have some weight. however I've had health professionals explain to me that one of the major advantages of the state funded scheme, is that if the poor are abandoned to be ill then there will eb a knock on stress effect on other levels of the economy. there will be a bigger pool of diseased individuals to infect the richer with the better health cover, If moor of the poor are off work sick, then the   management is stressed by having to do the same work with less staff. In the end it is a losing strategy for a society.

Any idiot can face a crisis - it's day to day living that wears you out.
by ceebs (ceebs (at) eurotrib (dot) com) on Thu May 4th, 2006 at 07:25:26 PM EST
[ Parent ]
our great grandparents knew this very well, when they said that an ounce of prevention is worth a pound of cure.


The difference between theory and practise in practise ...
by DeAnander (de_at_daclarke_dot_org) on Thu May 4th, 2006 at 09:01:28 PM EST
[ Parent ]
there is some good research being developed at UCLA that supports your intuitions.  one of the lead researchers has a book out, but I can't lay my hands on it right now.  I'll look.  It's still early stage research, and it will be controversial until proven one way or the other.  but the main researcher feels that being 7 or 8% below your "best weight" will lead to longer and higher quality life.
by wchurchill on Thu May 4th, 2006 at 10:54:52 PM EST
[ Parent ]


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